唑来膦酸对骨质疏松性椎体压缩骨折PKP术后疗效的影响

The effect of zoledronic acid after PKP in treatment of osteoporotic vertebral compression fracture

目的 比较椎体后凸成形术（PKP）后联合和不联合唑来膦酸（ZOL）对骨质疏松性椎体压缩骨折临床疗效的影响。方法 自2011-06—2013-03采用PKP治疗骨质疏松性椎体压缩骨折123例,比较应用与不应用唑来膦酸的2组住院期间及术后1年骨密度值、再骨折发生率,采用疼痛视觉模拟评分（VAS）评价疼痛程度。结果 试验组随访12-17个月,平均14.9个月;对照组随访13-19个月,平均15.4个月。试验组术前与术后1周VAS评分比较,对照组术前与术后1周VAS评分比较,差异均有统计学意义（P〈0.05）,2组术后1年VAS评分比较,差异有统计学意义（P〈0.05）。试验组术前与术后1年腰椎、髋部骨密度比较,差异有统计学意义（P〈0.05）,对照组术前与术后1年腰椎、髋部骨密度比较,差异无统计学意义（P〉0.05）,2组术后1年腰椎、髋部骨密度比较,差异有统计学意义（P〈0.05）。末次随访试验组再骨折4例,对照组再骨折13例,2组比较差异有统计学意义（P〈0.05）。结论 骨质疏松椎体压缩性骨折术后应用唑来膦酸明显增加了骨密度,减少了再次骨折发生率,有效减轻了腰背部疼痛症状,可作为PKP术后一种全身系统治疗的措施。

Objective To compare effect of percutaneous kyphoplasty（PKP） with or without Zoledronic acid on clinical efficacy of treatment of osteoporotic vertebral compression fracture. Methods From June 2011 to March 2013, 123 cases of osteoporotic vertebral compression fracture were treated with PKP. The bone mineral density value, the incidence of fracture and visual analogue score were compared between two groups（with or without Zoledronic acid） during hospitalization and one year after operation. Results The experimental group was followed up for 12 to 17 months, an average of 14.9 months.Control group was followed up for 13 to 19 months, an average of 15.4 months. The difference in VAS score before and one week after operation in experimental group, was statistically significant. The difference in VAS score before and one week after operation in control group, was statistically significant. Between two groups, the difference in VAS score one year after operation was statistically significant. The difference in BMD of lumbar spine and hip before and one year after operation in experimental group was statistically significant（P〈0.05） while in control group, the difference in BMD of lumbar spine and hip before and one year after operation was not statistically significant（P〉0.05）. The difference in BMD of lumbar spine and hip one year after operation between two groups of postoperative was statistically significant（ P〈0.05）. At the last follow-up, there were four cases of fracture in experimental group and 13 cases in control group, the difference was statistically significant（ P〈0.05）. Conclusion Application of Zoledronic acid after osteoporotic vertebral compression fracture can increase the bone density significantly, reduce the incidence of re-fracture, effectively relieve back pain symptoms. It can be used as a systemic treatment measures after PKP.